The provisions of the Patient Protection and Affordable Care Act (“PPACA”) have been rolling out in waves for almost three years. As individual provisions become effective, each generates a certain amount of buzz regarding its necessity, efficacy, and cost. Very little attention, however, has been devoted to an important provision that will become effective next year. Starting January 1, 2014, Medicaid coverage may extend to age 26 for many individuals who age out of foster care.
Despite important legislative bounds such as the Foster Care Independence Act of 1999, the unique needs of foster children and former foster children often remain unmet. This population continues to be disproportionately vulnerable to poor mental, physical, and emotional health, joblessness, poverty, homelessness, and criminal behavior. Many of these problems begin even before these children enter foster care. This new law not only provides former foster children with health care parity in relation to their peers (who may now remain on their parents’ insurance until age 26), but will also help prevent or ameliorate the other risks they face.
Currently, former foster youth may qualify for Medicaid coverage under several optional and mandatory programs, a number of which are optional at the state level and are often not fully utilized. The PPACA creates a new mandatory eligibility pathway for individuals who are (1) under 26 years of age, (2) not already enrolled in another mandatory Medicaid eligibility pool, (3) were in foster care upon reaching the age of 18, and (4) were enrolled in the Medicaid state plan while in such foster care.  The PPACA includes a number of other provisions that will benefit current and former foster children, including the ability of states to make “presumptive eligibility” determinations for these individuals.
The PPACA provisions affecting current and aged-out foster children have tremendous potential to improve the situation of these individuals, allowing them to integrate into and participate meaningfully in society as adults. States should enact the provisions fully and effectively as a matter of public health and social welfare.
J.D. Candidate, Class of 2013
S.J. Quinney College of Law
University of Utah
 Julie Stone et al., Cong. Research Serv., R4 1210, Mediciad and the State Children’s Health Insurance Program (CHIP) Provisions in the PPACA: Summary and Timeline (2010).